Could Strangers Do Skin to Skin?

Would you allow a stranger to cuddle your newborn baby?

When babies come to soon, when they are sick and need to be in hospital, parents desperately want to be near them. In my work in hospitals in Ethiopia and the UK as a lactation consultant, I met mothers and fathers spending countless hours by their child’s cot, helping with feeds, and when they could, holding their babies next to their skin, in kangaroo care.

Kangaroo care helps fragile babies survive, develop protection against allergies and infection, regulate breathing, temperature and heart rate. Ideally it should be with the baby’s mother, for as well as helping her bond and breastfeed, she is his ‘niche’. Nils Bergman, the South African kangaroo care specialist advocates skin to skin for all newborns: “The mother’s skin is the baby’s natural environment, and both physically and emotionally the healthiest place for the baby to be”,”We shouldn’t be measuring the mother-baby skin-to-skin time. We should be measuring the separation time. Skin-to-skin is the biological norm. Our focus should be on measuring and, therefore, minimizing the separation”.

However, for premature babies, skin contact is especially important.

Some kangaroo care experts reckon that during the last six weeks of pregnancy, babies in the womb sleep for 20-22 hours of the day. However, in the bright, noisy environment of the neonatal intensive care unit, they may spend less than two hours in really deep sleep. This has a big impact on their growth. In kangaroo care however, infants typically sleep more deeply and gain weight better than non-kangaroo care babies.

A 2017 study showed that 20 years down the line, premature babies who had been held in kangaroo care were less aggressive, less hyperactive, less anti-social and had less truancy. There is evidence that full term babies benefit too; they feel less pain when they are held in kangaroo care.

While most of the studies have been conducted with the baby’s mothers, fathers and other family members can offer a good alternative she is not available.

Unfortunately, distance from the hospital, travel expense and the need to care for other children, even to go back to work can sometimes make it impossible for family members to be there as much as they would like. And when the parents can’t be there, babies spend a lot of time alone in an incubator, sometimes undergoing painful procedures like feeding tube and cannula changes, tended to, but not always held, and not always comforted or stimulated when they need to be.

Why does it have to be this way?

In America, volunteer ‘baby cuddlers’ comfort hospitalised babies. They are grandmothers, students, people who were perhaps born prematurely themselves. They are background checked, vaccinated, and reliably turn up for evening and weekend cuddles when the baby’s family might not be able to get there.

“These babies need to feel love, human touch and a soft voice to comfort them when they’re in pain,” says Maryann Malloy, from the neonatal intensive care unit at Einstein Medical Center in Philadelphia.

“It makes the parents feel better knowing that even when they cannot be here there is someone to rock and hold their baby.”

A new study in Current Biology* found that this kind of gentle touch played a big part in the sensory development of premature babies; those who were cuddled and held by their parents or staff members had stronger responses to sensory stimuli than those who didn’t. Biologically and emotionally, touch matters for us humans, and more so for sick and premature babies.

In the UK, however, baby cuddlers are much less common. Some British mothers aren’t keen on the idea.

“I wasn’t able to see [my baby] until she was nearly 3 days old as I was in ICU… could you imagine if I’d have gone round to meet her for the first time and they’d already let a complete stranger hold her before I’d even met her yet?! That’d have finished me off I think! No way.”

Another mother added:

“We were in the hospital 24/7 and the thought of someone else taking one of her extremely precious cuddles away from me made me feel a murderous rage. I can see the benefit of babies whose parents cannot be there receiving it though!”

With mounting evidence about the benefits of kangaroo care, it’s clear that many improvements can be made in NICUs. Hospitals could make it logistically easier for parents to hold their babies skin to skin, offering child care facilities for older children, rooming in or free parking. Governments could offer longer parental leave for parents of premature babies. Nevertheless, even in an ideal world, there will be times when parents can’t be there. Could volunteers, or specially trained nurses do skin-to-skin contact with these babies?

It’s a question raised in my new novel, Open My Eyes, That I may See Marvellous Things.

I worked for four years in hospitals, including special care wards in Addis Ababa. Thanks to some innovative programmes, and the WHO’s Born Too Soon report, kangaroo care is starting to be accepted there as the superior way to care for premature babies. But in many wards, babies whose mothers were sick, babies who had been orphaned, or been abandoned lay alone in incubators, where, just as in the UK, they got little touch beyond feeding, nappy changing and medical checks.

I’d only recently weaned my second daughter when I started work in Ethiopia, and the instinct to hold these babies was overwhelming; they were so small, so alone and so vulnerable. Under-developed babies like them need to carry on their gestation period outside the womb, but of course, holding them in skin-to-skin was professionally off-limits.

My novel is an imaginative response to those babies. It’s set in Addis Ababa, and it asks, ‘how can you hold a baby next to your skin, without it touching your heart?’ It tells the story of Mariam, an adopted British midwife, who embarks on a project to protect an abandoned premature baby by doing kangaroo care. Her relationship with the newborn forces her to address her own abandonment years before. A mysterious character from the streets around the hospital is critical in determining the baby’s fate, as is a workaholic doctor, with whom Mariam finds herself falling love. Chapters of the book are related from the perspective of the premature baby.

Of course, my novel is fiction. There are enormous challenges to facilitating kangaroo care with volunteers. Infection control is paramount, then there are the logistics of vetting ‘kangaroos’. And of course, there are ethical questions; is it fair to ask staff and volunteers to get close, physically and emotionally, to tiny sick babies?”

Nevertheless, a system which isolates babies in boxes for long periods ignores our basic biology. I think it’s time to be starting creative conversations about the importance of human touch for newborns, and the power of skin contact in helping these tiny humans survive and adapt to the world.